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tv   Book TV  CSPAN  February 13, 2010 8:00am-9:00am EST

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break, you can do that and there is coffee and so forth and we'll begin the law enforcement and privacy panel promptly at 9:30. thank you. [inaudible conversations]:
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>> >> ok. we can start. i'm barbara mead, i'm one of the owners here at politics and prose and this evening, i want to welcome danielle ofri, danielle is one in actually a rather long list of doctors, literary doctors, who have visited politics and prose, actually just earlier this month, we had another doctor come and talk about his book, and there are a number of other literary doctors who have --
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you'll find that have been here to politics and prose, you'll find their names on the book, they have high words of praise for this. jerome groupman, dr. sachs and dr. gassie. danielle ofri is also a literary doctor, she is a co-founder and editor-in-chief of the bellevue literary review. she brought copies of it here this evening. you can see it. up here. and it's been going for almost a decade now. i think that's quite an achievement to keep a literary review going for almost over a decade when you're practicing medicine at the same time. and she has also, from her two previous books, which are up here, she has had essays selected that have been in the
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best american essays, the best american science essays, as well as the "new england journal of medicine." one of the things that i was interested in, in reading her book, is that she confides that every tuesday, she writes and practices the cello. she's a many sided doctor. danielle has practiced medicine at bellevue in new york city for almost two decades. and she works in an atmosphere where she's working with multiple languages, religions and races. who are all seeking health care. many of them are immigrants, some are legal, some are illegal. many are spanish speaking, and in a wonderful gesture of trying to become a better physician, danielle of ofri took a year's
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leave of absence from bellevue, and she and her family moved to costa rica where she could immerse herself into spanish. she also had though an experience that was -- gave her an opportunity to feel like maybe a lot of her parents in new york felt. she had a baby. so she was an alien in a foreign countrcountry, it was not her ne language and she was having a medical procedure. i think when she returned to bellevue the next year, that she could be much more sympathetic with the plight of her patients. but i thought that was just a wonderful thing for her to do. so danielle will read from her book, tell us a little bit about it and then if people with questions will please go to the mic. so here's danielle. [applause]
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>> good evening. thank you, barbara, thank you politics an prose and thanks to all of you for coming out, family and friends and other readers. it's really wonderful to be here. i'm an internist, a general internist and i work at bellevue hospital. contrary to popular belief, bellevue is not a mental hospital, it's a general public hospital. in fact, it's the oldest public hospital in the country. it started in 17 this 6 and continues to this day and as a public hospital in new york, it's been the magnet for the immigrant population in new york, because its doors have always been open to all, regardless of background and bellevue has seen the various waves of immigrants over the centuries. irish immigrants, jewish immigrants, arabic immigrants of all colors and flavors, and in bellevue, all the signs are in three languages, but apparently 40% of the literary population speak none of those languages, so it's always a challenge, but i think immigrants continue to come to bellevue, even when they've moved on to queens and
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westchester, because bellevue is very hospitalble to immigrants, there's always someone who speaks their language usually in the waiting room. the origin of this book actually started during that year in costa rica. i had always had this fantasy of writing a novel, and i couldn't imagine writing fiction in the way that i write nonfiction, which is piece meal essays, i really needed that time off, so i had this fantasy of going to live in another country, learn spanish, my children would be immersed in the language in another culture and so we worked out this year in costa rica, it was a wonderful year, that's where i actually took up the cello and started working on this novel. i had a wonderful time, wrote 350 pages, but it turned out when i got back, my editor and i read the 350 pages and they were ok but they weren't great, so we decided to tuck it under the bed with the other novels that are gathering prime new york city dust, but one of the themes in the novels that caught my editor's eyes and my eye was
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immigrants. and i had all these characters from different countries, so we decided to go back to non-fiction and focus on immigrants and the different populations that had come to bellevue and i think it's not an accident. there's to me an metaphor between immigration and becoming ill. when people emigrate from the land of the healthy to the land of the sick, it's like emigrating to a new country. there's a new language, new customs, new mores, and often you feel quite dazed and confused, even if you speak a new education, you're in a new world and you need an interpreter, a translator and sometimes that person can be translator and sometimes not and the person who are ill, they often feel like a foreigner in this strange and bizarre culture of medicine. so those parallels have intrigued me and then when i was in costa rica, i had the somewhat unexpected experience of being a patient in costa rica and i wasn't sick, i was just having a baby, but nevertheless, there was a chance to see a little bit of what it's like to be in that vulnerable position
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where you don't quite have a good command of the language and things are going on around you in a language that you have to really concentrate on and it gave me quite an appreciation for what my patients must go through. so on a given day in bellevue, there is really every language. i speak english only occasionnally or with an interpreter and i wanted to start with a short reading that is an experience that took place on the inpatient wards. i spend about 80% my time in the outpatient clinic and about 20% of the time on the inpatient wards. one month later, i was back on the inpatient wards. united nations was having some sort of flamboyant celebration. i didn't know what the occasion was, and bellevue hospital was not an official part of it. but because we were only a few blocks down the road from the u.n., we were the recipients of the fallout. the scene in the hospital was not too dissimilar from what i imagined the general assembly of the united nations to look like. envoys from the different nations were clumped into various locations throughout the
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e.r. identifiable by distinctive dress and accents. there was the begun nayan diplomat with acute enteris. there waenteris. a swiss non-governmental working had tripped off the curb. his group wore sleek double breasted suits and spoke in whispers, the histoniaans were louder. a malaysian driver with an asthma attack sat over in the asthma corner. 15 of his compatriots huddled over the nebulizer. we were assigned a 26-year-old tibetan worker brought in against his word. he had recently emigrated to the united states. he didn't speak a stitch of english, but he quickly had been
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absorbed by the tibetan community. the tibetans were out in full force during the u.n. celebration, he had been on a hunger strike for almost a week, along with a group of monks and some fellow political activists. during a shouting match with some chinese during the crowded human rights rally, he felt woozy and searched for a place to sit. groping for a bench outside the massive bodies, he became separated from his group, eventually staggering to the corner of east 42nd street. there, a policeman tried to assist him. frightened by the touch of anyone in uniform, he bolted, but he only managed a few yards before he collapsed and then an ambulance was called and now he lay on a gurney in the bellevue hospital emergency room. a rail thin man, a course of shock black hair that spilled over his forehead. his eyes were vivid, frightened.
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he had ripped out the i.v. and the bloody bandage was all that remained on his arm. his two hands gripped the safety rhames of the gurney. his knuckles frail from the compressive force. he looked as though he could vault himself over the rails if he had the strength. there was no one in the e.r. who spoke tibetan. someone spoke at&t, but they didn't have an interpreter available at that moment. call back in an hour, we were told. his blood pressure was low, 80 over 60 and his pulse was race, indicating severe fluid depletion. his life wasn't in the immediate danger, but he needed urgent hydration. when we approached him with the i.v. kit, we could smell the fruity continuing of ketosis on his breath, as the intern began to sterilize his arm for the i.v., he pushed us away. i tried to indicate an i.v. in the arm and fluids flowing
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through but he yelled something at me, a barrage of incomprehensible words. it was obvious he didn't want our medical care. because of the serious nature of his condition, it was imperative for us to assess his decisional capacity to refuse treatment. more important, we wanted to convince him to accept treatment. i called back at&t, still no interpreter available. without an interpreter, he was isolated in an impenetrateble bubble, within the chaos of bellevue. an orderly with a crew cut and football sized biceps strode over and kicked loose the foot brake on his gurney without a word. when the gurney began to move, the patient pulled himself up, his eyes widening in panic and he began protesting again in tibetan. where are you going, i demanded to the orderly. 17 north, he snapped. the tatoo on his left bicep said campaign focampaign for liberty- carnersi. when the bed is ready, we have to go. when the e.r. is backed up, they
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tell us to get our [beep] in action, pardon my french. he pushed the gurney into a service elevator at a new york clip and our theme scrambled to cap up with him. the service elevator at bellevue was a no nonsense event. a scuffedly knoll yum floor. where to, the operator grunted as we prowled into the car. 17, the orderly said. step on it. the doors rumbled closed and the elevator lurched upward with a jolt. the patient was silent now, but his fear stricken eyes started jerking from one corner of the elevator to the other. his fingers were still gripping the bars on the gurney. the muscles of his slender arms quivering from the effort. the elevator operator sat hunched on his tool, head sung into his shoulders. the collar of his jacket
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reaching up for the tops of his ears. he stared, unmoving at the con solutions. com's buttons directly in front of him. they're keeping you busy tonight. i wasn't sure to whom he was talking, but the orderly answered. e.r. is busting at the seams, this has got to be my 20t 20th trip and my shift isn't half over. the elevator operator continued to address the console in a mono tone. i hear that stuff happened up at the u.n., everyone knocking everybody over. yeah, said the orderly, like this chinese dude here, the orderly said looking down at the patient on the gurney. he's not chinese, i said, he's tibetan. the orderly shrugged, chinese, tibetan, whatever, i just get them where they've got to go. the elevator operator punched the buttons on his console, never shifting his gaze towards any of us. tibetan food is different from chinese food he said, less greasy, more soupy.
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that nurse aide in pete tricks once brought me some tibetan food, she's a decent cook. the elevator came to a halt on 17 and we all spilled out. the orderly hustled the patient over to his room and i grabbed one of the medical students by the elbow. go down to pediatrics, i said, it's on 7 or 8, i can't remember, see if you can dig up that nurse aide from tibet. 20 minutes later the student returned, jubilant at having located the sole representative of the tibetan nation at bellevue hospital. the nurse aide was short, well under 5 feet, with a round face and silky hair pulled into a tight bun. she was monumentally pregnant. the belly on her petite stature suggested dangerously unstable structural dynamics. nevertheless, she moved nimbly, her last name was the patient's first name. i walked beside her on the way to the patient's room. some rising concerns to us, she nodded but said nothing, as i
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reminded her we needed to explicate the risks and benefits of refusing treatment. when we entered the room, the medical student quickly purple the chair up for the nurse aide. as she didn't look like she could stand for much longer. when she dropped into the sagging chair, her head aligned at the level of the patient's gurney. she began speaking in a low voice and the effects on the patient was immediate. his hands loosened their grip on the rails, easing themselves down on to the bed, the agitated corrugations on his face settled and the terror in his eyes receded. his whole body seemed to sigh. the aide did most of the talking, the patient offering only one word answer. for 15 minutes she spoke while the rest of us watched in silence. the aide's voice resembled an oboe. air filled, legatto, haunting.
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it had a soothing effect on all of us, including the patient. abruptly she stopped speaking, stood up and turned to us. you may proceed, she said. there is no problem. the nurse aide pivoted toward the door and we jumped to cap up with her. what did he say, i asked? is he didn't say anything she said. i just told him of what i remember about tibet when i was a little girl, he reminded him of the beauty of our country and the mountains. i told him that the mountains would weep if we lost him. she pressed a button for the service elevator. i told him that it was ok for the fast to be over, that it was ok to eat, that's all he needed to hear. the doors opened, the ukrainian elevator operator was still hunched on his stool. the aide reached one hand under her belly to support it. he will be ok, she said and the doors closed. when we returned to the room, the patient stretched his right
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arm out to us, resting his forearm on the metal rail. the intern pulled out a tourniquet and began preparing for an i.v. the patient didn't flinch as the needle slid in. his eyes eased closed as the fluid entered his veins. when i stopped by an hour later, one of the nurse aides was helping him with a bowl of broth. the aid i can't say jamaican and she chatted to her charge. encouraging him to sip one spoonful of a another, with each bite she cajoled, the patient hesitated, then accepted, and so it went, round after round, until the bowl was empty. the aide did not let up her sing song jamaican monologue for one moment. as i turned to leave, the aide raised an eyebrow at the patient, then tore open the top of a chocolate pudding with gusto. she rattled on, evidently with praises about bellevue's chocolate pudding. the patient opened his eyes for a bite, it was clear that he understood. it was well past dark when i walked home from the hospital
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that evening. the streetlamp at first avenue created parallel orbes of light, illuminating the north-south artery. looking uptown, i tried to convince myself that i could make out the united nations, perched on a rise in the manhattan topography, just 14 blocks from where i stood. the truth was, that it was all a jumble of lights right now, but that didn't really matter. i knew that it was there, that my crow chasm of the world, -- microcosm of the world, crammed into a monolithic office building. i often thought of the u.n. and bellevue as sister organizations, both trying to cajole a babble of languages into a comedy of either the political or the corporate real sort. in any case, i was relieved when the patient was finally getting the medical compare that he needed, that his body would finally be able to rest and perhaps his soul could too. by the time i got home, supper was finish and the kids were already in bed. i tugged open the drawer in which wested the bounty of takeout menus that were edged
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uno our doors each day. i leafed through the menus for the local afghani, chinese, thai and turkish restaurants. i put aside the mexican, italian and moroccoan one. i knew there was a tibetan menu, but i hadn't eaten there. i sorted through the men news until i finally found it. there were dumplings, sorted stews and curries, i settled on the savory soup. i ordered two portions, since i doubted that the patient's digestive system was ready for the eggs and dry that is that would likely show up on his breakfast tray tomorrow. thank you. [applause] >> thank you. i'd be happy to take any questions.
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>> as 1 who spent some time in tibet, i really enjoyed that piece. i would like to ask you a little bit about the experience that you see of foreign born physicians who come to the united states to practice, what you think their perspective is, an conversely, a number of american young people and maybe not so young if to caribbean, to go to medical schools there and the dynamics must be interesting as well, so i would be curious as to your views of becoming a physician, or in getting more training as a physician, in different cultural settings. >> that's a wonderful question. thank you. it's interesting. as i was writing this book, there was one section i was writing a little bit about religion, one day when patients just seem to always be asking and talking about religion, and our die that mix have shifted quite a bit to southeast asian
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and formerly it was entirely white, chinese or jewish and n.u. was often called ny jew or n.y.chu and that has changed and that creates a sort of comfort level with our patients, even patients of different descents. i think patients are used to doctors' unpronounceable names. and patients are so used to people being from various places and it does bring interesting perspective. i recommend the book "my own country" he talks about a foreign medical graduate practicing in appalachian and how stereotypes play a role and conflict with various images of disease, so i think it's been a benefit to diversifying our physician work force. i think the patient base is actually diversifying faster than the physician base. there's still groups that we've never encountered before, languages that we haven't heard of, dialects that we can't get interpreters for.
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and i think that americans training abroad also get this experience of seeing other cultures. there's another world out there. things are done differently, even just spending time in costa rica, which is a fairly westernized country, but medicine is different. it was good, it was adequate, but things were clearly different and i wouldn't have known that had i not been there, had a chance to be a patient. >> hello. thank you some for the book, and the topics, it's so important. i'm a physician assistant, and am part of emergency medical reserve corps and my question actually is around the issue of translation for people who do not speak english. i ask this question -- let me first explain, during anser sighs, having been born in denmark, i was part -- i spoke only danish in anser sighs to work with the whole issue of
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emergency in community, and it took eight attempts through using telephone, through using people, to try and figure out that they couldn't figure out which language i was speaking. i was speaking only danish, and i asked the question, to help us understand what kinds of attempts are being made at your hospital or that you know of, to help with this issue as we do get more and more people who speak many different languages, and it's for all of us in community to be sensitive to these issues, because if there should be an emergency in hour community, we really all as community can help in whichever ways that might be and if we know languages, we can identify, but you may know of some things that are being done that can be helpful for us to think about. >> well, thank you for that question. in fact, there's been quite an evolution in translation
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services, so when i trained, there were none, except the clerks who spoke spanish and some of the orderlies who maybe spoke chinese. there will be overhead pages, anyone speak portuguese, if there's a croatian speaker, come to pediatrics. sometimes it was the 6-year-old child, a fairly bilingual uncle calling in from his taxi and there were pluses or minuses to the system. the at&t operator became the last resort, it was very expensive, so we were admonished to use it very, very sparingly. also, we had to hand the phone back and forth. then we had volunteer interpreters, often students from bilingual homes would come from local colleges and spend an afternoon, but it was only french on wednesday of afternoons, and senegaly on thursday afternoons and we got the two cell phone head sets where you had two cell phones, two head sets that you wired up,
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untangle them and dial in some certain codes and you could get about six languages and that was a marvelous thing, although you had to constantly untangle the phones. then we had a language line that was outsourced and it wait a minute with a phone with two handsets and you could dial in for certain languages, but there was only one phone per floor, so you had to find the floor, get your i.d. card, get the key, so that could often be a barrier. now we have interpreters in house and i have a little bit in the book about that, so there are a certain number of interpreters who are in house and we have remote simultaneous translation, which is an incredible thing, so i call, you know, 1-800, press pound 2 for french and a french interpreter materializes into the ether, so we speak simultaneously. so my patient begins speaking simultaneously and a beat or two of a that, i hear the english in my year, but it's an interesting phenomenon who have simultaneous
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translation. for starters, the patient is speaking at a regular room volume talk in french, west african french usually, the interpreter is speaking very feint english in my ear and i can't focus on the english if i'm hearing this french loud and clear two feet from me, so i have to tune out the patient, of course, we're always trained, focus on the patient, ignore the interpreter, put the interpreter behind the patient, but there really isn't any way to have your brain focus on what you're hearing and listen to the words and the meaning while someone is speaking right in front of you, so i find that both the doctor and the patient look away. we both naturally do that, because we can't. we get too confused if we're looking at each other and there's two different languages at different tempos going on, so it has that impracticality a little bit and also loses the part will schmoozing, the part that gives you the doctor-patient connection, where you have the bit about your
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patient, the family, how did you get here, things that seem less relevant to the doctor-patient relationship, but often what cement the sense of trust and when you have an interpreter, you feel kind of bound to really just get to the practicalities of things, you can't just chat, so i find that it's much harder to have that aspect of the doctor-patient relationship, the part that's actually not going to be the most fun, but it's eons better than what we had, and now the patient can make themselves understood. that doesn't mean their culture can be translated, so there can be many challenging things, there's a little 6 in the book where i was talking to one of the interpreters and he was confused about the terms illness and disease, becaus because in , there was only one word as well as spanish, he also troubled with abbreviations such as h.i.v., which didn't exist for him in french, we had to spell that up, but then he said what's up with the term water pill.
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why do doctors say you're taking a water pill, why don't you just say diuretic. first of all, the diuretic we have is kind of a tongue twister, so it seems to complicate it and the word diuretic seems to complicate, so we all say water pill, the pill that makes you produce water, he said -- the patient said to most haitians, the water pill has nothing in it, it's just a placebo, and i said really, is that what my patients are thinking, no wonder no one takes the medicines prescribe and i said in english, we call it a sugar pill, he said oh, in haitian, we think a sugar pill has something in it, but a water pill has nothing if it. so it's things that transcend actual language. he then explained to me for the patients he speaks to in haiti, from growing up there, he knows that there's no concept of an illness without a visible wound. so if you tell a patient they have cancer inside their body or
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hypertension and they don't see a wound, they don't feel sick. and although they'll say yes to everything the doctor says for being polite and traditional, they won't have any concept of having an illness that requires treatment and he cited many situations in which he could translate the doctor's words and the names of the disease, and particularly cancer, there wasn't a concept for it, and that patients would say yes and then never show up for followup, because they didn't feel that it was an illness until they saw an oozing wound and often at that point it was a little that late, so the interpreters often need to be cultural interpreters as well and that's a whole different realm and their job is to translate the words in the language, but sometimes they'll have to stop and say i think the patient, this concept isn't getting across, screening is a concept that doesn't exist in some cultures, hooking for a disease before you actually have it and then there's now issues of liability. now that translationer services are so -- translation services
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are routine, can there be an error from an i want pretzel crusted crabber and i'm sure the interpreters are terrified and i'm sure there is a layer between us, even though i have someone whose fidelity is transmitting the words, i can't always be sure that someone understands. remind me once in the days of before i want pretzel crusted pd crabbers having an elder man who spoke mandarin and his grandson spoke can't niece and mandarin, and his friend spoke only mandarin, and at so the translation went up and down, six rounds later, i would get a three round answer and then i would ask the clarification, up and down the line, everyone had their layers of not just translation but opinions to go into it, so there are many, many aspects of translation beyond just the language. currently in hour hospital, there are signs everywhere that have about 10 languages, in that language, i speak korean,
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senegaly, yiddish, i need an interpreter, so someone can point to the sign. if you don't speak one of those 20 languages -- but it can be difficult if you speak a rare language, it certainly has happened. i had a woman on the ward just this past month who spoke a dialect of chinese that almost no one spoke, there was no at&t operator who spoke that dialect and someone spoke can't niece could make herself understood to the patient panned could folsom of her language, but we really couldn't be sure the woman really understood what was going on, so there's always a challenge going on. >> i was wondering if you saw this recent article in the new york magazine that kind of spoke about the americanization of mental diseases. and kind of what it explained was that western science and particular in the, you know, mental illness realm, was so
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elevated, mental diseases are cured outside of the western world were almost like pushed aside and -- or were rediagnosed and were therefore, you know, the traditional method of curing those or treating those diseases were also overlooked or disregarded. and i was wondering -- and i guess there is an inherent danger in that, and i was wondering at bellevue hospital, kind of ever trains their -- because you have to deal with such a multicultural patient, you know, train doctors like maybe in non-western medicine or, i don't know, techniques -- because there is these like cultural discrepancies that occur. >> we're not yet that sophisticated where we have such multifaceted education and clearly should. mental illness is an interesting subset, because so many aspects of mental illness are culturally determined. when someone is psychotic, it can be very culturally determined and also, some things
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that might appear psychotic in western culture are in fact part of the culture that are not a symptom of mental illness, voodoo aspects in haiti, this gentleman was telling me, can come across as psychotic, as delusional, yet they're completely accepted aspects of normal functioning. so there is a kind of a whole set of variations that the culture, you know, a wonderful book is "the spirit catches you when you fall down" which really shows how the cultures vary so greatly and what our definition of illness is, particularly mental illness, or neurologic illness, in this case, can often be quite different so we can often miss the boat, so we probably should be getting more education. at this point, most of us get the education i think from our patients, a little piece meal, but it's certainly in realtime, but it's a place we need to strive for. thank you. >> can you talk about what you see as your i guess covenant
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with patients in terms of being the one who tells their story instead of them telling their story as you write. >> as a writer. even one of the epics of writing about a patient. >> yeah. how do you feel about what your obligations are and how much leeway you have, and how much, you know, you can say that you -- >> well, that's obviously a fascinating question an one that concerns anyone who writes about patients, there are many issues there. legally, when i first wrote my first book, i talked to our risk management, i didn't want to get in trouble and they said there was really only two issues really. there is libel, that you're not committing libel and that you change the patient's name, identifying characteristics beings and you're done from our perspective. but i think that for a doctor, the bar needs to be much higher. clearly, this is not a journalist, an interviewee, a patient comes to you for help, they are vulnerable, they're trusting, and there is an assumption of confidentiality,
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so the bar has to be very high and when i first started out, i made it my business to attend he lecture of a visiting doctor and ask that question, what do you do and the answers vary, so all our facts would say, their story, your story, as long as you change the name, it's fine, it's your story too. sharon at columbia, she gets informed consent and reads the story with the patient as part of a therapeutic form, show there's a whole variety of opinions. for me, one of the things, in my first two books, a lot of time passed from when the events occurred to when i wrote about them hand the truth was at that point, many patients were far gone in many respects. i probably couldn't contact them. but i did have one patient who in my second book, i wrote just as the book was going to press, i had a really interesting patient and i wanted to write about him, and when i went to see him, he was a gentleman who
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was -- he looked kind of homeless to me, although he was found in an apartment wedged between the bathtub and the sink and there was things piled up and he hadn't come out in a while. it was a strange story. he just looked really beaten by life. and -- but he told me all these stories about being in the small business hall of fame and all the things he invented and patented and lectures around the world, didn't seem to jive with who this fellow was and i walked if and my book was on his night stand in the hospital and i never talk about writing and it turned out the neurology consult mentioned it, so anyway, we got into a discussion about writing, so i told him that i wanted to write about him and he said sure, just let me see it. my editor was appalled, she said no, i'm the editor here, i said i need to feel as though i need to have him see it. one the cardinal tenets is it can be harmful to the patient. if the patient found it harmful, i couldn't publish him, so i
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sent him the manuscript and i waited and waited and finally he called and i was sure he'd be concerned about my kind of implications that he had an unraveling of his life, that clearly he had some kind of functional life and clearly he had reached a state that either mental illness or paranoia, something had got him to a stage to where he was. but that wasn't bothered him. what bothered him was the physical description of what he look like. the part i would call the most objective, because he didn't see himself that way. he said is that what i looked like and the truth is, it's what he look like. he looked like he had been living on the bowery and he had never seen himself and i was holding this mirror to him that he never had. he was crushed but he said it was ok to publish, so i invited him to the reading at the west side y and he showed up in a suit jacket, dark hair, silver cane, and i had never seen him in a healthy state, so it was an education for both of us. so if i can show the work to the patient, in this current book, i
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actually did interview some my patients and i could show them the manuscript, to get their consent. if i can't, i have to make a decision, do i think it's a respectful rendering, i want to be honoring my patients, not exploiting them hand this is clearly subjective, but that's the bar. i have one where i think it's a great story about a patient who lied to me and the i am my cases of that lie in our relationship and it was a thought touched upon a fascinating topic about doctor-patient relationships, but he's the guy who might see it. he's the poet, he reads literary journals, he would be hurt if he saw it, so it's back under the bed. one more question? >> it's kind of related to what you just said. do you encounter hippa problems? >> oh, yeah. then there's hippa. hippa, the pain of other lives. hippa is the law that is intended at least in part to protect patient's of confidential and the practice has become a nightmare of bureaucracy and makes it very
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hard to just function in general, although i appreciate the underlying theme of this, the law. so i -- i don't know the answer to that question, and i figure when the lawyers call me, then i'll know. i want to talk to you about one aspect of the book, about our survivors of the program so nyu-bellevue has a wonderful program founded by my colleague, adam keller, for patients seeking political asylum. we get patients from many countries, it's the diversity of torture and abuse in this world is staggering, and the program is comprehensive to provide psychiatric, medical, legal support, for the medical side, they ask for volunteer physicians to see some patients to screen them and most of us volunteer one session a week, most people can't do more than one, so for me, mondays at 1:00 p.m. is my time, my slot for an s.o.t. patient and i never know what that day will bring. last monday, i had a gentleman from afghanistan, my first
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patient from afghanistan, a lot of west african patients, tibe tibetan, eastern european patients, and they bring very unique problems, most of them in fact are quite healthy, political opposition tends to be for the young and the healthy, no, sir for the old and infirm, so they tend to be young, otherwise robust people, aside from what has devastated them, physical, psychological, sexual torture, so i don't have much often medical to do for them. it's rare they have a medical illness. that i can actually help them with. but most of them have post-traumatic stress disorder and they have nightmare, flashbacks, difficulty adjusting to american society. sometimes they find the freeness and openness in america can be overwhelming, they're a little dazed from that experience, so mondays at 1:00 p.m. are probably my hardest times of the week. tuesdays, as barbara mentioned, are my days are not in the hospital. tuesday is my writing and cello
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lesson and it's a little bit of my chance to unwind from the mondays. and i'll read just a brief section from that. >> michelle low teacher clipped two photocopy sheets of paper from his bag and smoothed them on to my music stand. the moment had finally arrived. at of a three years of -- after three years of sweating through simplified excerpts, it was time to start the bach suites. the six uncompany cello suites by bach, the first suite is most famous and has been overplayed, but like other over played works, four seasons and mozart, the underlying music is still spectacular, no matter how often it's been dredged up from of movies, tv commercials and cell phone ring tones, to listen to it again may feel overly familiar, but to play it -- well, that was another matter entirely.
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it was an opportunity as a doctor-musician colleague once put it to touch the members of greatness. monday afternoons with s.o.t. patients were daunting, the breadth of brutality of human beings never ceased to astound. the energy, effort, and creativity invested in destroying the human body and spirit seemed limitless. what sort of response could i offer that was meaningful in the face of such overwhelming trauma? no matter what i said or did with my s.o.t. patients, it always felt useless. it was a different feeling of uselessness than i felt for example, with a patient dying of can certificate. disease, no matter how painful or humiliating or even self-inflicted was something that occurred, disease utilized intransitive verbs, but torture was something done by somebody to somebody. having a leg amputated from the complications of diabetes wasn't
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the same as having it hacked off by a machete. i felt i had something in my repertoire to offer the patient who was having a foot amputated. it wasn't just that there were medical treatments for the diabetic to prevent the next amputation, but the diabetes was an entity separate from one's self-and didn't have a face. nobody did diabetes to anyone. the disease just occurred. torture on the other hand had a face. somebody, an actual person, did it. a human being raised a knife, poured the acid, heaved the boot, set the fire and that is what made these patient encounters so unsettling, above and beyond contemplating the horror that the victim himself had endured. somebody did this, some member of our humanity and whether i liked it or not, i was part of that same humanity. the sheet music of the first bach suite appeared
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straightforward. no in trifle indicate timing, no double sharps, no clef shifts, no fancy ornamentation, but as anyone with bach knows, it is -- one measure needs to be memorized, expect to put in hat least a year on this. this was said without irony. week of a week, month after month, i tip toed begin gervaisly through the music. i found myself focusing ever more narrowly on a single page, a single line, a single measure, evening a single note. temperamentally, this was the exact opposite of the din of minutia that clatterred around the halls of the hospital. but then, there was a step even beyond that. the note didn't merely have to be right, it also had to be beautiful.
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beauty gets short shrift in medicine. beauty is inherently unpragmatic. it doesn't enhance productivity, earn a grant, or cure a patient, but it feels necessary. when i survived a measure and to play several notes in sequence, the beauty was astounding. the type of beauty that really does take your breath away. i sometimes feel as though i have to stack up bach against bin laden, and all the random dictors who litter the globe. there had to be counterbalance in this world, a counterbalance that was metaphorical, to live in this world, i had to live -- i had to know that beauty balanced reality. there were others who existed only to create beauty. the chance to graze that beauty, only fleetingly, was sometimes
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the only thing that kept the last straw at bay. >> we're in georgetown university with sarah bender, who is a co-author of "politics or principle, filibustering in the united states senate." to begin with, what is a filibuster, where does that word come from? >> well, the word actually comes from the dutch, from a word that i think they call freebooter when translator, which basically applied and meant pay rights, who were -- pirates, who were basically going across the seas, killing everything in sight and that's the sort of thing that filibustering senators can't be stopped.
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they can talk and talk until the senate can cut them who have. >> how did it start, is there such a thing in the constitution? >> well, the constitution says one thick about congressional rules, it says the house and senate can set their own rules. funny enough the house and senate in 1789, basically had the same set of rules. it wasn't until early in the 1800's, the senate had a rule, which the house has today, we call it the previous question motion, it's used to cut of off the bait by majority vote. the senate had it, it wasn't really using it, they didn't know how to use it, they got some advice to clean up the rule book and out it goes, and once it's gone, there's no way for majority to cut off debate. i don't think the senators reallynd stood what they were doing in 1806 when they cleaned up the book, but when filibusters start to heat up, partisanship heats up in 1830's and the great senators we talk about that want to talk debate can't, because there's no rule
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in the senate rule book that allows majority to cut off debate. >> couldn't they just change the rules? >> well, over time, senators have tried to change the rooms. they have introduced rules to ban the filibuster. what happens when you introduce a rule to ban the filibuster? somebody filibusters it, so we have efforts to change the filibuster and that's essentially where we are today. there's a process for changing filibusters, but it takes 67 votes and we just got to 60 votes in the senate, the senate democrats, and still we don't have 67 votes to change the rule. >> what are some of the earliest uses of the filibuster, what are some of the issues? >> well, we see filibusters start in earnest in the late 1830's, 1840's and they occur on the big and small issues of the day. we see them on the national bank, right, we see them on andrew jackson's behavior over the bank, we see them over who should be the printer of the united states senate, we see them over slavery, we see them over extension of slavery in to
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the territories and of course, we see them civil war and beyond. >> what were some of the earliest successful uses of filibuster? >> well, we -- in heap of these episodes, we see successes. we see minorities blocking the extension of slavery, we see battles over can i can't say, nebraska, we see battles between the democrats and the questionings over andrew jackson and losing deposits at the bank. it's pretty successful early on because the minority can outlast the majority. >> what i read in 1917, there was some sort of a landmark event with woodrow wilson and world war i. what was that about? >> in the runup to world war i, woodrow wilson is trying it get the senate and the house to pass a bill that will allow them to harm merchant ships so they won't be attacked.
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that bill is filibustered in 1950, there's a huge filibuster and eventually wilson's bill is public. he says look, there's a ban of what he called willful men, 11 senators blocking essentially the u.s. arming itself for world war 1, and he essentially shames the senate to pass the bill and then he calls the creation of the rule basically we call it rule 22, the cloture rule. he says this is a war measurement we can't be a nation that can't go to war and he induces a large majority of the senate to introduce the cloture rule. that allows senators with a high super majority to cut of off debate. >> so as a scholar who studied this issue hat that point, what's your opinion of that, is that a good thing, is that a bad thing, or does that not enter into it for you. >> the idea to get a cloture rule? well, the senate, before then, was essentially ungovernable, right. we look at today's senate and we
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say oh, this is terrible, it's never been so partisan, it's never been so petty, but with if he look at the 19th century senate, it was just as bad. senators perceived it to be just as bad and they would issues over civil rights obviously, anti-lynching laws, poll taxes, all sorts of issues coming up that the senate could not act, and in light of that, it's pretty appropriate for the senate to try to change the rules of the game, so at least certain majorities can work their will. it would be better if the bodies would work their will, but as of yet, we had supermajority rule in the senate. >> what about the house, why aren't they the same? >> well, the senate early on got rid by mistake i think of the pivotal previous question motion. the rule they need. the house kept it and in fact, they sort of massaged it in a way that it became an instrument of power for the majority party and majorities realized that, so they had a rule that cut of off debate and they used it to get
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other rules that empowered the majority party, so let's say we want a rule, you can only talk for five minutes on an amendment, the majority proposes the rule, the minority tries to block it, they can't, because they need a rule to cut of 0 the debate and that empours majorities over the history of the house, so today, we have basically a house majoritian house, very strictly run by the majority party. in the senate we have the precise opposite, not that is true it was intended that way, but that's an historical accident. that's how they developed. >> what about that notion that the senate is it a tea saucer that's supposed to cool heat, was this any kind of intention from the founders that the filibuster was there? >> well, the short answer to that is no. the founders knew full well the dangers of supermajority rule. they had it under the articles in the federation. the con federation couldn't act.
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they knew full well that supermajorities knew that minorities could take legislative bodies hostage. so they thought we're going to empower the senate and house to create their own rules. >> a lot of people think of filibuster, probably think of jimmy stewart and mr. smith goes to washington, i'm sure people asked you that before, that seems like a classic thing. we don't see that on c-span. why don't we see that on c-span? >> well, this is the question everybody reasonably asks. why doesn't the majority challenge the minority to stand up just as jimmy stewart and speak all night. why not make them filibuster and the argument today goes look, maybe the republicans filibuster and the assumption is, republicans will be shamed, will give up and the majority will get what they want. i don't buy it for one instant, all right. first of all, minority party, i don't think it's much of a cause for them if they think they're going to win.
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their position to republican constituencies over health care and many other issues is popular in the republican constituencies, so there's probably a benefit to them talking all night, but to the majority party, there's a big cause imposed minority. if you keep the floor and filibuster for two weeks, three weeks, nothing else gets done. majorities today have agendas, they want to use the floor to get things done. even the minority party senators i think want to use the floor at times to get things done and if you wrap the senate in a filibuster, an all night after night after night, what's going to be the end result? the public is going to look at it and say what are you doing. : count them.
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we can count culture of votes. how many times as the majority leader gone to the floor after the motion and tried to get a
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debate. you can't really tell those. an exponential increase after the 1970s and increasingly higher in the last couple years. no doubt that leaders are trying to gain youth culture. the majority will say we have to and the minority will say you are too quick. let's have time to talk before you go back. >> what is the cause of these. >> it is a little bit of both. the last 20 plus years they have been trying to adapt to no obstructions. any time the majority tries something the right finds another way to get out of it. it is the most visible effort by majority leader's to slow down the unpredictability in the senate. this legislative body to
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legislate or consider things carefully and come to a vote. it is kind of like coming to a vote. that is what raises my alarm bells. >> a lot of commentary now suggesting republicans have 41 in the senate and run the senate, where does that come from? what do you think of when you hear people say that? >> it is an admission of the reality of the 60 vote senate. the incentive to disagree, partisan incentive with the other team. if the majority will work -- if
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they don't have 59, the new wisdom is making it exceedingly tough for the majority to work as well. they have to incorporate consent and the question is how are democrats going to entice enough republicans to come over to vote with democrats. >> i want to ask about your suggestions for reform. i don't know if you have looked at other countries in the world but is there such a thing? does the filibuster exist around the world and if not why not? >> i don't know enough about other legislatures. there are some that have supermajority requirements. california has one in and anything related to texas. legislators have a tough time moving. >> what

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